- Being prepared
- Gas and oxygen
- Caesarean section
- Vacuum extraction
- Forceps delivery
- Apgar score
- Mix-ups impossible
- Premature babies
- Overdue babies
In debating whether to give you pain relief, the obstetrician always has to consider two persons: you and your baby. Giving birth is a great strain on both, both physically and mentally.
The birth pangs are not dangerous; rather, they help the birth along. Knowing what to do and what to expect is the best form of pain relief. The more you know about the delivery, the easier it is to be sensible. People always fear the unknown and new experiences, and they feel pain more when they are afraid. The main thing is to learn to relax and to breathe properly at each stage of labour. This is the best possible way to help your baby, because it ensures that it gets as much oxygen as possible. Unlike many painkillers, it does not sedate the baby in any way.
If necessary almost every mother can, however, receive effective pain relief during delivery. About 15-20 % of mothers feel the pain is so bad that special measures have to be taken. The trouble is that the painkillers quickly spread through the placenta to the baby’s blood system and may hinder the newborn baby’s breathing if the birth comes within 2-3 hours of the last dose of medicine.
Painkillers are not, therefore, recommended towards the end of labour.
A mixture of nitrous oxide and oxygen can safely be administered throughout the first stage of labour because they are very quickly expelled from the circulation. Inhalation is timed to coincide with the contractions, but the effect is so slow that you must begin inhaling before the contraction begins. The same applies to other gases, too.
Local anaesthetics also pass through the placenta and may slow down the baby’s heartbeat. They may also temporarily impair the circulation of the uterus and placenta and cause an oxygen deficiency in the baby. Such anaesthetics can, therefore, only be given if the baby is in extremely good condition, which can be determined from its ECG.
The most effective and safest type of nerve block is an epidural, which relieves the pain either entirely or al- most entirely during the first stage of labour. The anaesthetic is injected into the lower part of the back and can be added to throughout the delivery. It must, however, be administered by an anaesthetist and cannot therefore be given in every hospital.
On average, 15 % of deliveries call for some special measure: caesarean section, vacuum extraction, breech or forceps delivery.
Breech delivery. About 3 % of babies are born bottom first, a few even feet first. This is usually spotted at the clinic and the hospital may try to turn the baby into the right position. If it fails to turn, however, the delivery mode will be decided beforehand according to the size of the baby and the mother’s pelvis.
Caesarean section tends to be recommended more often than normal for a breech delivery, especially for a first or premature baby.
About one mother in eight has a caesarean section in Finland. The most common reasons are if the baby is becoming short of oxygen during labour, if the placenta is low-lying or there is a risk of haemorrhage, or if the pelvis is too narrow for a normal delivery.
The baby is delivered by an operation to enter the uterus through the lower abdomen. The placenta and foetal membranes are removed at the same time. It usually takes longer for the mother to recover from a caesarean than from a normal delivery and she will not usually be discharged from hospital until 8-10 days after the birth.
Caesarean sections can be done under a general or epidural anaesthetic. In the latter case the mother is awake and can experience the birth. The operation usually takes 30-40 minutes.
A mother who has had a caesarean section may still have a normal delivery for another baby. Normal delivery is not, however, considered possible after repeated caesareans.
If the baby is suffering from lack of oxygen or the uterus is not contracting sufficiently strongly and the pushing stage is delayed, the baby may be helped into the world with a suction cup. The doctor applies a plastic or metal cup to the baby’s head, creating a vacuum that makes it stick to the baby’s skin. He can then get a firm grip on the baby.
The mother must still push; the suction cup merely helps. 2-3 % of all deliveries are by vacuum extraction. The method does not harm either mother or baby. The bump forming on the baby’s head vanishes in a few days.
At one time forceps deliveries were just as common as vacuum extractions are today. Forceps were used instead of caesarean sections in the case of difficult deliveries. This is why they are often feared. Forceps deliveries have once again become more common during the past few years. They are in particular resorted to if the baby’s heartbeat gets slower in the final stage of labour and the baby is becoming short of oxygen. It is then possible to help the baby out much faster with forceps than with a suction cup, thereby avoiding the danger of oxygen deficiency. Forceps are in this case a quick, good, safe method.
Immediately the baby is born the mucus and amniotic fluid are removed from its nose and mouth. It is then given what is known as an Apgar score to indicate its heart rate, colour, breathing, general body tone and reactions to stimuli.
The maximum score is 10. In practice one point is almost always lost for colour. The score should not be given too much importance.
Even before the umbilical cord is cut, babies are marked to ensure they cannot get confused. They are usually given a plastic wristband and a chain round their neck with a number plate while still in the delivery room. Mother and baby are given the same number.
A premature baby is one born more than four weeks before it is due. In this case not all its organs are fully developed. A premature baby easily loses heat and needs to be fed often to give it sufficient energy .To begin with it is usually kept in an incubator, where it is easier to keep an eye on and where its heat loss can be prevented. The baby can go home when its weight has risen to 2,200 grams. Its parents should visit it and care for it as much as possible while it’s in hospital.
A baby is said to be overdue when the pregnancy has lasted for 42 weeks. A special watch must then be kept on both mother and baby.